1. Class 2: Kidney disorder: Urinary disturbance (Lin), Retention of Urine
Xianhui Li

2. Edema
Subcutaneous retention of fluid which leads to puffiness of the head, face, eyelids, limbs, abdomen and even the whole body is called edema.

3. Etiology Exterior wind and dampness Diet Overwork
Excessive sexual activity
Fire-poison from sores or carbuncles
carbuncles
Carbuncles: fen ci

4. Pathogenesis
Yang edema
Yin edema

5. The main points that promote the transformation, transportation and excretion of fluids
Du26 shui gou: this point promotes the transformation of fluids in the upper burner, for edema of face and hands
Ren9 shui fen: this point can be used as a general point to promote the transformation of fluids anywhere in the body
Ren5 shi men: this is the front mu point of triple energizer and it promotes the transformation and excretion of fluids in the lower burner, essential in edema of the lower burner
ST28 shui dao: this is an essential point to promote the transformation and excretion of fluids in the lower burner
Ren17 shan zhong: it stimulates the diffusing and transformation of fluids in the upper burner
Ren6 qi hai: it promotes the transformation of fluids in the lower burner by activating qi
UB22 san jiao shu: back shu point of the san jiao. It promotes the transformation and excretion of fluids in the lower burner
Ren5: on the anterior midline, 2 cun below the umbilicus
ST28: 3 cun below the umbilicus, 2 cun lateral to CV4 guan yuan

6. The main points that promote the transformation, transportation and excretion of fluids (continued)
LU7 lie que: it makes lung qi descend and diffuse and it promotes the diffusing and transformation of fluids in the upper burner in lung pathology, for edema of face and hands
SP6 and SP9: both these points stimulate the transformation and excretion of fluids in the middle and lower burner, essential in spleen pathology
KI7 fu liu: promotes the transformation and excretion of fluids in the lower burner, essential in kidney pathology
UB13, UB20 and UB23: these are the back shu point of the lung, spleen and kidneys. They are used to tonify the lungs, spleen or kidneys in chronic yin edema
Ren5: on the anterior midline, 2 cun below the umbilicus
ST28: 3 cun below the umbilicus, 2 cun lateral to CV4 guan yuan

7. Pattern identification
Yang edema
Wind water invading the defensive qi portion
Fire poison affecting the Lung and Spleen
Accumulation of dampness
Accumulation of damp-heat
Yin edema
Spleen Yang deficiency
Kidney Yang deficiency

8. Wind water invading the defensive qi portion
Clinical manifestations:
edema of eyes and face with sudden onset, aversion to cold, fever, aches in muscles, retention of urine. Light red tongue, thin white or thin yellow coat. Floating pulse.
Treatment principle:
Release the exterior, expel wind, open water passage, stimulate the lung’s dispersing of fluids
Acupuncture LI4, TB5 wai guan, LU7 lie que, BL12 feng men, BL13 fei shu, DU26 ren zhong, ST36, LI6 pian li
LI4 yuan point of LI, LU7 luo point of LU, TB5 luo point of TB, BL12 and BL13 release the exterior, expel wind and restore the lung’s dispersing and descending function.
Du26 promotes the transformation of fluids in the upper burner, for edema of face and hands
ST36 tonify the spleen and harmonizes nutritive and defensive qi and removes fluids from the space between skin and muscles
LI6, luo point of LI, opens the water passages and resolves acute edema of the upper limbs and face
Herbal treatment: yue bi jia zhu tang

9. Fire poison affecting the Lung and Spleen
Clinical manifestations:
edema of any part of the body, sores, carbuncles or furuncles, red tongue, thick yellow coating. Rapid pulse
Treatment principle:
Clear fire poison and drain dampness
Acupuncture Ren12 zhong wan, BL20, BL22, Ren9 shui fen, ST28 shui dao, LI11, LU7, BL13, SP9, local points
Ren12 and BL20 tonify the spleen to resolve dampness and edema
Ren9, ST28 and BL22 promote the transformation of fluids and resolve edema
SP9 resolves dampness
LU7 stimulates the lung’s diffusing of fluids
BL13 tonifies lung qi
LI11 resolves toxic heat
Herbal treatment: ma huang lian qiao chi xiao dou tang and wu wei xiao du yin
Furuncles: ding chuang, jie
Carbuncles: fen ci

10. Accumulation of dampness
Clinical manifestations:
edema, scanty urination, heavy body, poor appetite, oppression of the chest, sticky white tongue coating, slippery pulse
Treatment principle:
resolve dampness and strengthen spleen
Acupuncture Ren12, BL20, BL21, ST36, Ren9, ST28, Ren6, SP6, SP9, BL22, BL39 wei yang
Ren12, BL20, BL21 and ST36 tonify stomach and spleen
Ren9 and ST28 resolves edema
Ren6 with moxa, tonifies and moves yang qi, which will help to move and transform fluids and resolve edema
SP6 and SP9 resolves dampness
BL22 stimulates the transformation and excretion of fluids in the lower burner
BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
Herbal treatment: wu ling san and wei ling tang
BL39 lower he sea point of san jiao

11. Accumulation of damp-heat
Clinical manifestations:
edema, scanty dark urination, heavy body, oppression of the chest, sticky yellow tongue coating, slippery rapid pulse
Treatment principle:
Clear heat and resolve dampness
Acupuncture Ren12, Ren9, ST28, SP6, SP9, BL22, LI11, BL39
LI11 solves damp heat
SP6 and SP9 resolves damp heat from the lower burner
Ren9 promotes the transformation of fluids and the separation of clear from turbid. It resolves edema
ST28 promotes the transformation of fluids in the lower burner and resolves edema
BL22 promotes the transformation and excretion of fluids in the lower burner
BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
Herbal treatment: shu zao yin zi, ting li da zao xie fei tang

12. Spleen Yang deficiency
Clinical manifestations:
edema of the abdomen and/or legs, feeling of oppression of the chest and abdomen, loose stools, poor appetite, fatigue. Pale swollen tongue with teeth-marks, weak fine pulse.
Treatment principle:
tonify spleen and resolve dampness
Acupuncture Ren12, BL20, BL21, ST36, Ren9, ST28, Ren6, SP6, SP9, BL22
Ren12, BL20, BL21 and ST36 tonify stomach and spleen
Ren9 and ST28 resolves edema
Ren6 with moxa, tonifies and moves yang qi, which will help to move and transform fluids and resolve edema
SP6 and SP9 resolves dampness
BL22 stimulates the transformation and excretion of fluids in the lower burner
Herbal treatment: shi pi yin

13. Kidney Yang deficiency
Clinical manifestations:
edema of the whole body or legs, sore back and knees, feeling cold especially in the back and legs, scanty or profuse urination, fatigue, pale or bright-white complexion, pale swollen tongue with teeth marks. Deep weak pulse.
Treatment principle:
tonify kidney and resolve dampness
Acupuncture Ren 4, BL23, BL20, ST36, KI7, BL22, ST28
Ren4 with moxa, tonifies kidney yang
BL23 and KI7 tonifies kidney yang
BL20 and ST36 tonify the spleen, in edema form kidney yang deficiency. In edema from kidney-yang deficiency it is essentila to tonify the spleen as well
BL22 and ST28 resolve edema
Herbal treatment: ji sheng shen qi wan and zhen wu tang
KI7 tonify kidney, resolves dampness, opens the water passages of the lower burner and resolves edema, strengthens the lower burner, regulates sweating

14. Nocturnal Enuresis
Nocturnal enuresis is referred to involuntary discharge of the urine occurring at night and during sleep. As a morbid condition, it is mostly seen in children over the age of three years and occasionally in adults.

15. Etiology
Kidney Qi deficiency

16. Kidney Qi deficiency Main Manifestations Treatment principle:
Involuntary micturition during sleep, once in several nights in mild cases, or several times a night in severe cases. Sallow complexion, loss of appetite, pale tongue, thin white coat, thin pulse weak at the chi region.
Treatment principle:
Strengthen kidney and reinforce Qi
Acupuncture Treatment: BL23 shen shu, BL28 pang guang shu, Ren3 zhong ji, SP6 san yin jiao
BL23, BL28 and Ren3, back shu points of the kidney and bladder, front mu point of the bladder, this three points contribute to reinforce the kidney qi and the restrain function
SP6 is added to adjust the qi of the three yin meridians
Herbal treatment: suo quan wan

17. Urinary Disturbance
Painful-urination syndrome, called Lin in Chinese, refers to a condition of urinary dysfunction characterized by frequency of urination, pain, scanty urine, urgency and difficulty.
Includes the western medical conditions of acute and chronic urinary infection, bladder or kidney stones, acute and chronic prostatitis and chyluria

18. Etiology Invasion of exterior damp heat Improper diet Emotional stress
Indulgent sexual activities

19. Pathogenesis Heat Lin Stone Lin Qi Lin Blood Lin Sticky (Cloudy) Lin
Full type: full heat
Empty type: empty heat
Stone Lin
Full type
Qi Lin
Full type: stagnation of qi
Empty type: qi deficiency or qi sinking
Blood Lin
Full type: blood heat
Empty type: blood or qi deficiency
Sticky (Cloudy) Lin
Full type: dampness
Empty type: dampness with qi deficiency

20. Heat Lin Clinical manifestations: Treatment principle:
frequent, scanty and difficult urination, burning pain on urination, dark urine with a strong smell, bitter taste in the mouth, pain on the sacrum, constipation, thirst. Red tongue, yellow sticky coating, rapid slippery pulse.
Treatment principle:
Clear heat, drain dampness, and open the water passages
Acupuncture Treatment: Ren3 zhong ji, BL28 pang guang shu, BL22 sanjiaoshu, BL39 weiyang, ST28 shuidao, SP9 yinlingquan, SP6 sanyinjiao, Du14 dazhui, LI11 qu chi
Ren3 and BL28 clear heat and drain dampness from the bladder
BL22 drain dampness from the lower burner
ST28 and SP9 drain dampness from the lower burner
SP6 clears heat and cools blood, drains dampness from the lower burner and calms the spirit
DU14 and LI11 clear heat
BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
Herbal treatment: ba zheng san

21. Stone Lin Clinical manifestations: Treatment principle:
stone or sand in the urine, difficult urination which may stop suddenly, sacral pain, blood in urine, red tongue with thick-sticky coating. Rapid, wiry pulse.
Treatment principle:
Open the water passages and expel the stones
Acupuncture Treatment: Ren3, BL28, BL22, BL39, SP9, ST28, Ren6
Ren3 and BL28 clear heat and drain dampness from the bladder
BL22 drain dampness from the lower burner
ST28 and SP9 drain dampness from the lower burner
BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
Ren6 moves qi in the lower burner, moving qi helps to transform fluids and drain dampness
Herbal treatment: shi wei san

22. Qi Lin Clinical manifestations: Treatment principle:
Full type: difficult and painful urination, hypochondrium pain and distension, irritability, wiry and deep pulse.
Empty type: difficult urination, weak constitution, tiredness, pale tongue, week pulse
Treatment principle:
Full type: move qi, eliminate stagnation, open the water passage
Empty type: tonify and raise qi, open the water passage
Acupuncture Treatment Ren3, BL28, BL22, BL39, SP9, ST28, SP6
Ren3 and BL28 clear heat and drain dampness from the bladder
BL22 drain dampness from the lower burner
ST28 and SP9 drain dampness from the lower burner
SP6 drains dampness from the middle and lower burner and calms the spirit
BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
For liver qi stagnation: LIV3, LIV5
For Qi deficiency: ST36, Ren6
Herbal treatment: chen xiang san or bu zhong yi qi tang
LV5 luo point of the LV, promotes the smooth flow of liver qi, resolves damp-heat in the genitourinary system

23. Blood Lin Clinical manifestations: Treatment principle:
Full type: difficult urination, burning pain on urination, blood in the urine which could take the form of small clots, mental restlessness, red tongue and rapid pulse.
Empty type: blood in urine, slight pain on urination, low back pain, 5-palms heat, hot flushes. Red tongue without coating, thin rapid pulse.
Treatment principle:
Full type: Clear heat, cool blood, stop bleeding and open the water passage
Empty type: nourish yin, clear heat, stop bleeding and open the water passage
Acupuncture Treatment: Ren3, BL28, BL22, BL39, ST28, SP9, SP6, SP10, BL17,
Ren3 and BL28 clear heat and drain dampness from the bladder
BL22 drain dampness from the lower burner
ST28 and SP9 drain dampness from the lower burner
SP6 clears heat and cools blood, drains dampness from the middle and lower burner and calms the spirit
BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
SP10 and BL17 tonify the blood and cool the blood
Full type: DU14, LI11
Empty type: KID2, Ren4, KI6, KID3
Herbal treatment: xiao ji yin zi or zhi bai di huang tang

24. Cloudy Lin Clinical manifestations: Treatment principle:
Full type: turbid or cloudy urine like rice soup, difficult urination, a sticky tongue coating and a slippery pulse
Empty type: turbid or cloudy urine like rice soup, slight difficult urination, tiredness, dizziness, lower back pain, pale tongue with sticky tongue coating and a weak pulse
Treatment principle:
Full type: drain dampness, separate the clear from the turbid, open the water passages
Empty type: tonify qi, strengthen kidneys, separate the clear from the turbid, open the water passages
Acupuncture Treatment: Ren3, BL28, BL22, BL39, ST28, SP9, SP6
Ren3 and BL28 clear heat and drain dampness from the bladder
BL22 drain dampness from the lower burner
ST28 and SP9 drain dampness from the lower burner
SP6 drains dampness from the middle and lower burner and calms the spirit
BL39 lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
For kidney Qi deficiency: ST36, Ren 6, KI3, KI6
Herbal treatment: cheng shi bi xie fen qing yin or gao lin tang

25. Retention of Urine
Retention of urine is a disease manifested by difficult urination, distending pain in the lower abdomen and even blockage of urine.
The mild case refers to difficulty in urination and dripping of urine
The severe case refers to failure in urination with distension and feeling of urgency.

26. Etiology and pathogenesis
Exterior or interior heat
Kidney deficiency
Traumatic injury or surgical operation

27. Pattern identification
Accumulation of heat in the bladder
Decline of Mingmen fire
Damage of the qi of the meridian

28. Accumulation of heat in the bladder
Clinical manifestations:
Scanty hot urine or retention of urine, distension and fullness of the lower abdomen, thirst but with no desire to drink, constipation, red tongue with yellow coating, rapid pulse.
Treatment principle:
clear heat and promote urination
Acupuncture: BL28, Ren3, BL39, BL22, SP6, LI11, DU14
BL28 and Ren3, back shu point and front mu point of the bladder, both can reduce heat from the bladder and adjust its function
SP6 can dispel heat from the lower jiao and drain dampness from the middle and lower burner
BL22, back shu point of sanjiao, drain dampness from the lower burner
BL39: lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
LI11 and Du14 clear heat
Herbal treatment: ba zheng san or dao chi san

29. Decline of Mingmen fire
Clinical manifestations:
Dribbling urination, weakness of the loins and knees, cold limbs, listlessness, pale tongue with teeth marks, deep thin weak pulse.
Treatment principle:
Warm kidney yang and facilitate urination
Acupuncture: BL28, Ren3, BL39, BL22, SP6, DU20, Ren4, BL23, Ren6, DU4, KI 3, KI6, KI7
BL28 and Ren3, back shu point and front mu point of the bladder, both can reduce heat from the bladder and adjust its function
SP6 can dispel heat from the lower jiao and drain dampness from the middle and lower burner
BL22, back shu point of sanjiao, drain dampness from the lower burner
BL39: lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
BL23, Ren6, BL23, DU4 tonify kidney yang
Moxa to Ren4 and Du20 can ingorate kidney qi,
KI 3, KI6, KI7 tonify kidney
Herbal treatment: ji sheng shen qi wan

30. Damage of the qi of the meridian
Clinical manifestations:
Dribbling urination or retention of urine, distension and pain in the lower abdomen, purple tongue with spots, wiry pulse.
Treatment principle:
Promote the circulation of qi and facilitate urination
Acupuncture: BL28, Ren3, BL39, BL22, SP6, ST28 shui dao, KI5 shui quan
BL28 and Ren3, back shu point and front mu point of the bladder, both can reduce heat from the bladder and adjust its function
SP6 can dispel heat from the lower jiao and drain dampness from the middle and lower burner
BL22, back shu point of sanjiao, drain dampness from the lower burner
BL39: lower he sea point of san jiao, opens the water passages in the lower burner, stimulates the transformation and excretion of fluids in the lower burner
KI5 xi cleft point of the kidney combine with ST28 may promote urination and relieve distension and pain
Herbal treatment: chen xiang san